100 Cases in Clinical Medicine

274 Pages · 2015 · 13.63 MB · English

  • 100 Cases in Clinical Medicine

    xa0 100 CASES

    in Clinical Medicine

    xa0 100 CASES

    in Clinical Medicine

    Second edition

    P John Rees MD FRCP

    Consultant Physician and Professor of Medical Education, King’s College

    London School of Medicine at Guy’s, King’s and St Thomas’ Hospitals,

    London, UK

    James Pattison DM FRCP

    Consultant Nephrologist, Guy’s and St Thomas’ NHS Foundation Trust,

    London, UK xa0

    Gwyn Williams MD FRCP

    Emeritus Professor of Medicine, King’s College London School of Medicine at Guy’s,

    King’s and St Thomas’ Hospitals, London, UK First published in Great Britain in 2000 by Arnold

    This second edition published in 2007 by

    Hodder Arnold, an imprint of Hodder Education and a member of the Hodder Headline Group,

    338 Euston Road, London NW1 3BH


    Distributed in the United States of America by

    Oxford University Press Inc.,

    198 Madison Avenue, New York, NY10016

    Oxford is a registered trademark of Oxford University Press

    © 2007 P John Rees, James M Pattison and Gwyn Williams

    All rights reserved. No part of this publication may be reproduced or transmitted in any form

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    publisher or a licence permitting restricted copying. In the United Kingdom such licences are

    issued by the Copyright Licensing Agency: Saffron House, 6-10 Kirby Street, London EC1N 8TS.

    Whilst the advice and information in this book are believed to be true and accurate at the date

    of going to press, neither the authors nor the publisher can accept any legal responsibility or

    liability for any errors or omissions that may be made. In particular (but without limiting the

    generality of the preceding disclaimer) every effort has been made to check drug dosage;

    however it is still possible that errors have been missed. Furthermore, dosage schedules are

    constantly being revised and new side-effects recognized. For these reasons the reader is

    strongly urged to consult the drug companies’ printed instructions before administering any of

    the drugs recommended in this book.

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    British Library Cataloguing in Publication Data

    A catalogue record for this book is available from the British Library

    Library of Congress Cataloging-in- xa0Publication Data

    A catalog record for this book is available from the Library of Congress

    ISBN-10 0 340 92659 7

    ISBN-13 978 0 340 92659 8

    Commissioning Editor: Fiona Goodgame

    Project Editor: Jane Tod

    Production Controller: Lindsay Smith

    Cover Designer: Laura de Grasse

    Indexer: Laurence Errington

    Typeset in 10/12 RotisSerif by Charon Tec Ltd (A MacMillan Company), Chennai, India


    Printed and bound in Spain

    What do you think about this book? Or any other Hodder Arnold title?

    Please visit our website at www.hoddereducation.com CONTENTS

    Preface vii

    Acknowledgements ix

    Abbreviations xi

    Section 1: Systems-related cases 1

    Cardiology 3

    Respiratory 9

    Abdomen 14

    Liver 19

    Renal 23

    Endocrinology 27

    Neurology 33

    Rheumatology 37

    Haematology 43

    Infection 47

    Section 2: General self-assessment cases 53

    Index 257

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    xa0 PREFACE

    Most doctors think that the most memorable way to learn medicine is to see patients. It is

    easier to recall information based on a real person than a page in a textbook. Another

    important element in the retention of information is the depth of learning. Learning that

    seeks to understand problems is more likely to be accessible later than superficial factual

    accumulation. This is the basis of problem-based learning, where students explore prob-

    lems with the help of a facilitator. The cases in this book are designed to provide another

    useful approach, parallel to seeing patients and giving an opportunity for self-directed

    exploration of clinical problems. They are based on the findings of history taking and

    examination, together with the need to evaluate initial investigations such as blood inves-

    tigations, X-rays and ECGs.

    These cases are no substitute for clinical experience with real patients, but they provide a

    safe environment for students to explore clinical problems and their own approach to

    diagnosis and management. Most are common problems that might present to a general

    practitioner’s surgery, a medical outpatients or a session on call in hospital. There are a

    few more unusual cases to illustrate specific points and to emphasize that rare things do

    present, even if they are uncommon. The cases are written to try to interest students in

    clinical problems and to enthuse them to find out more. They try to explore thinking

    about diagnosis and management of real clinical situations.

    The first 20 cases are arranged by systems, but the next 80 are in random order since, in

    medicine, symptoms such as breathlessness and pain may relate to many different clinical

    problems in various systems. We hope you enjoy working through the problems presented

    here and can put the lessons you learn into practice in your student and subsequent career.

    P John Rees


    James Pattison

    Gwyn Williams

    January 2007 This page intentionally left blank


    The authors would like to thank the following people for their help with illustrations:

    Dr A Saunders, Dr S Rankin, Dr J Reidy, Dr J Bingham, Dr L Macdonald, Dr G Cook,

    Dr T Gibson, Professor R Reznak, Dr B Lams, Dr J Chambers, Dr H Milburn and Dr J Gilmore.

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